Chronic Bad Breath Can Be A Warning Sign

Nearly all of us have bad breath at one time or another. Some of us have chronic bad breath, better known as halitosis, nearly all the time.

Only about 1% of all cases of chronic bad breath are caused by a serious medical condition, but if yours is one of those cases in the 1%, your breath can be an important diagnostic sign that you can use to get timely, in many cases emergency, medical care. It’s highly unlikely you will ever need to know about any of the following unique bad breath odors associated with medical emergencies, but it’s vital that you pay attention and get care if these combinations of symptoms arise.

A Fruity, Chemical Odor

Sometimes type 2 diabetics develop an oddly chemical yet fruity bad breath odor that some describe as a cross between grape jelly and nail polish remover. This type of bad breath is most often caused by diabetic ketoacidosis, a potentially fatal condition that requires hospital care.

The underlying health issue in diabetic ketoacidosis is blood sugars spiraling out of control. In type 2 diabetes, insulin resistance, which is something like cells shutting off the switch that allows insulin to transport glucose inside, protects the energy-making machinery in cells of most of the tissues of the body from absorbing so much sugar that they are overcome by free radicals of oxygen. When the muscles and the liver and certain other tissues become insulin resistant, glucose is left in the bloodstream. The pancreas attempts to reduce blood sugar levels by producing still more insulin, and tissues respond by becoming still more insulin resistant.

Sometimes blood sugars can rise to levels that make the blood literally syrupy. Blood flow slows throughout the body. Urination may stop. Eyesight may become cloudy. The brain probably will receive enough energy, but nerves misfire and mood swings and poor judgment follow.

The tissues that aren’t using sugar as fuel use fat, with the creation of ketone bodies. Some of these ketone bodies are exhaled with the breath and smell like nail polish remover, which is mostly acetone. The excess sugar in the bloodstream is noticeable on the breath with a fruity smell. The combination of acetone odor and fruity odor is a key diagnostic sign of diabetic ketoacidosis—which can easily result in death if not treated—but the change in breath odor does not occur by itself.

Fecal Breath Odor

Another distinctive breath odor that indicates a medical emergency is an odor on the breath that one would ordinarily associate with bowel movement. This is not the odor of methyl mercaptan, the volatile sulfur compound produced by bad breath bacteria that smells like sewer gas. This odor smells like feces because it actually is feces, regurgitated into the lower throat because the colon is blocked.

A surprising number of people in two very different groups have this condition. Blockages of the colon, or ischemic colitis, occur in about 20% of people over the age of 85 whose inferior mesenteric arteries (the blood vessel providing oxygen and nutrients to the left side of the colon) no longer function. They also occur in athletes (especially Iron Man triathletes on the island of Hawaii) and people who become severely dehydrated during intense physical activity. Both groups are likely to suffer intense upper left abdominal pain—preceded by intensely odorous breath. If you believe you may have become dehydrated, your breath smells like bowel movement (this is one kind of bad breath odor the person who has it will notice in a big way), and you have abdominal pain or cramping, seek medical attention immediately. Do NOT take any food or fluid by mouth until you see a doctor for evaluation.

Fish Breath Odor

Another distinctive diagnostic symptom is bad breath that smells like rotting fish. It’s not that hard to identify the odor of rotting fish. Fish sauce served in certain Asian dishes is literally made by letting fish lie out in the sun and collecting the fluid that they ooze as they decay. It’s an easily recognizable odor.

In people who have chronic kidney disease, the kidneys lose their ability to clear amino acids from the bloodstream. One of the first chemicals to build up in the bloodstream is creatinine, which forms compounds that cause fishy breath. It’s also possible to develop fish breath odor after ingesting too much selenium (typically by taking too many selenium supplements).

Chronic kidney disease will cause weight loss, severe fatigue, skin problems, swollen joints, and other symptoms. It’s easy to test for, requiring just a simple blood test, but hard to treat. Acute kidney failure may also produce fishy breath—it’s most common after an injury or poisoning. And selenium poisoning will cause changes in the skin and nails as well as the breath. It’s most common after overdosing nutritional supplements but it can also occur after eating too many (more than 20) Brazil nuts.

“The Kiss of Death”

There is also a kind of bad breath that was once known as the “kiss of death.” It occurs during liver failure, which may be chronic, caused by ongoing alcohol or drug abuse or ongoing liver disease, or acute, caused by certain kinds of poisoning.

The kind of bad breath caused by liver failure has an especially putrid odor. It is not “fecal,” but it may include concentrated methyl mercaptan, which is also the odor component in sewer gas. Yellow or orange tinting of the skin and eyes usually accompanies liver failure. Bad breath alone is never the only diagnostic sign. Simple blood tests can detect liver failure very quickly—and treatment is sometimes possible.

These four kinds of chronic bad breath are warning signs of serious health issues—but they never occur as a solo symptom, and they affect fewer than 1 in 100 persons who has bad breath.


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